Florida House seeks changes to lower health costs

TALLAHASSEE, Fla. - House Speaker Jose Oliva on Tuesday promised that his chamber would focus on lowering health-care costs, seeking to change how and where health providers can work.

Hours later, the House Health Quality Subcommittee approved bills that would do just that, mostly over the objections of Florida’s powerful physician organizations, which expressed concerns that the proposals would expand scopes of practice for non-physicians.

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“It’s all about access,” said subcommittee Chairwoman Colleen Burton, R-Lakeland, referring to the bills. “We heard a lot of bills today; next week, I’m sure, we’ll have as many.”

To help address a psychiatrist shortage that has hampered access to mental-health care, the panel approved a bill filed by Rep. Cary Pigman that would allow certain psychologists to prescribe drugs. Pigman, an emergency-room physician from Avon Park, routinely files legislation to broaden the practice areas of non-physicians and allow them to work more independently.

Psychiatrists and psychologists both treat mental-health conditions using psychotherapy and evidence-based interventions. But psychiatrists are physicians who have drug-prescribing authority. Psychologists are not physicians and cannot prescribe.

According to a staff analysis of the bill, Florida has the second-highest psychiatrist shortage in the nation. The shortage of about 1,000 psychiatrists is projected to increase by 48 percent by 2030.

While the bill (HB 373) cleared the panel by a comfortable margin, some members expressed concerns.

Rep. Randy Fine, R-Palm Bay, said that while he’s generally supportive of expanding scopes of practice, he worries about allowing psychologists to prescribe medications.

“In this case, I get nervous,” he said adding, “we are talking about mind-altering drugs to little children. And those are the issues where you can’t get it wrong. It’s not Tylenol, this is not a flu test, this is not Tamiflu.”

Fine ultimately supported the bill, but he wasn’t the only lawmaker who expressed reservations. Rep. Carlos Guillermo Smith, D-Orlando, said Florida has a mental-health crisis and said it was fueled by lack of psychiatrists and not enough funding for services.

“Is this ideally where I think we should be going? No,” Smith said. “But this is the environment we are in. We have to do something to address the shortage of mental-health care professionals, particularly psychiatrists.”

Oliva on Tuesday morning kicked off the 2019 legislative session with a brief speech. During the speech Oliva called health care a “five-alarm fire” that needed to be doused. Part of Oliva’s strategy is to reduce regulations about health-care facilities and change the roles of providers.

“Floridians are depending on us to remedy this crisis,” he said, noting that health costs gobble up personal budgets and the state budget. Spending across the state’s health-care and social-services agencies accounts for more than 40 percent of the overall budget.

The Health Quality Subcommittee also overwhelmingly supported a bill (HB 111) filed by Rep. Rene Plasencia, R-Orlando, and Rep. Tyler Sirois, R-Cocoa, that would expand the role of pharmacists. In its original iteration, the bill would have allowed certain pharmacists to test for and treat the flu and strep throat so long as there were written agreements between pharmacists and Florida-licensed physicians.

The committee, though, tagged on a lengthy amendment to the bill, expanding it to also allow pharmacists to enter into written agreements with collaborating physicians. It would allow pharmacists to treat the collaborating physicians’ patients for chronic medical conditions, including arthritis, asthma, diabetes, emphysema, hypertension and congestive heart failure.

Nuland said the bill would allow for what’s called “differential diagnosis” and that pharmacists aren’t qualified to do that. As an example, he said the bill would allow pharmacists to treat and manage congestive heart failure. It also would allow them to test and screen for skin conditions.

“What this strike-all (amendment) does is not just increase the scope of practice for a pharmacist --- which we would be against, anyway--- but you are potentially removing the patient’s personal physician from the direct care of the patient. And we do not believe that is in the best interest of the patients,” Nuland said.

But Fine dismissed Nuland’s remarks, noting that patients wouldn’t be authorized to be seen by pharmacists unless the patients’ physicians entered agreements with the pharmacists.